Juvenile Idiopathic Arthritis (JIA)

JIA Facts

• Yes, Arthritis can occur in children too…
• Arthritis in children is different from that of adult with arthritis
• Arthritis in children is not inherited from parents except in some types of JIA
• Arthritis in children is treatable)
• If diagnosed early and treated with appropriate medication then child can live normal live
• Some children can have remission in their disease

• Juvenile- Less than 16yrs of age
  Idiopathic –Exact cause is unknown,
  Arthritis-Inflammation of joint must last more than 6wks
• This type of arthritis can occur at any age starts from the first yr of age upto 16yrs of age
• JIA is completely different from rheumatic fever where ASO titer has been increased
• Apart from joint pain JIA can present as long duration of fever with skin rash, increase in lymph node, and eye inflammation
• There are several types of JIA

• a) JIA-Oligoarticular:
   Usually involve less than 5 number of joints
   Girls are more risk than boys
   Occur mostly less than 7yrs of age
   Increased risk of silent inflammation of eye (Chronic Uveitis) who has ANA positive
   Some extended into polyarticular (>5joints) after 6months of onset of disease

• b) JIA- Polyarticular:
   Usually involve five or more joints
   Can occur at any age
   Sometime same as adult with rheumatoid arthritis
   Those have Rheumatoid factor positive has persistent disease and may extend into adult rheumatoid arthritis

• c) JIA-ERA (Enthesitis Related Arthritis):
   Usually affects young boys of age more than 6yrs of age
   Develop low back pain more in the early morning while after getting up from bed, heel pain
   Lower limb joints such as knee, hip and ankle joints are commonly involved
   Sometime can have sudden pain and redness in the eye (Acute anterior Uveitis)
   This group is same as ankylosing spondylitis (AS) of adult age group
   Mostly have HLA B 27 positive
   Usually have family history of similar disease

• d) Systemic Onset JIA (SOJIA / Stills disease) :
   Systemic onset JIA is otherwise known as Still’s disease
   Child will have long duration of fever without any identifying cause for it.
   Usually 3-6 yrs of age are involved. Boys and girls are equally involved
   Along with long duration of fever the child develop skin rash and arthritis during spike of fever
   During afebrile period child is normal and playful
   Apart from fever, there is enlargement of lymph node, spleen and liver
   It is a diagnosis of exclusion i.e. you should exclude infection and sometime malignancy

• Juvenile arthritis affects children of all ages and ethnic backgrounds.
• Depending upon the type of JIA the age group varies
• JIA- Oligoarticular - less than 7yrs of age,girls are more risk than boys
• JIA-Polyarticular-Can be seen at any age upto 16yrs of age
• JIA-ERA-usually boys with more than 6yrs of age
• SOJIA(Stills Disease)-at any age but mostly in the 3-6 yrs of age

• JIA is an autoimmune disorder.
• As a rule, the immune system helps fight off harmful bacteria and viruses. But in an autoimmune disorder, the immune system attacks some of the body’s healthy cells and tissues.
• No known cause has been pinpointed for most forms of JIA, there is no evidence to suggest that toxins, foods or allergies cause children to develop JIA.
• Some research points toward a genetic predisposition to JIA, which means the combination of genes a child receives from his or her parents may cause the onset of JIA when triggered by other factors.

• Most common symptom is joint pain and swelling more in the early morning for more than 6wks of period
• JIA-ERA child will have more of low back pain in the morning, heel pain, arthritis involving joints of the leg
• Sometime child will have long duration of intermittent fever with skin rash along with lymph node, liver and spleen enlargement
• Child can have frequent painful redness of the eye and difficulty in vision (recurrent anterior uveitis)
• Sometime due to late diagnosis child may develop deformity, limping while walking
• Parents should always watchful on the child if he or she is not playful with their friends / limping while walking/difficulty in writing because of joint pain

• JIA sometime difficult to diagnose because some children may not complain of pain at first and joint swelling may not be obvious.
• JIA should be diagnosed as early as possible to prevent the deformity of the joint
• There is no blood test that can be used to diagnose the condition.
• As a result, diagnosis of JIA depends on physical findings, medical history, and the exclusion of other diagnoses.
• Arthritis more than 6wks and age of onset less than 16yrs of age and excluding other etiology for the arthritis
• The most important step in properly treating juvenile arthritis is getting an accurate diagnosis.
• There is no single blood test that confirms any type of JA. Sometime investigation were done to exclude other causes.
• In children, the key to diagnosis is a careful physical exam, along with a thorough medical history.
• Any specific tests a doctor may perform will depend upon the type of JA suspected.

• There is no substitute to proper detail history and thorough clinical examination
• Blood tests and radiological tests were done to confirm the diagnosis and exclude other diseases.
• Blood test:
   Complete blood count
   ESR
   CRP (quantitative)
   Liver function test
   Rheumatoid factor
   ANA titer (Hep2)-for chronic Uveitis
   HLA B27-For the JIA ERA
   Sometime Bone marrow test to rule out malignancy
• Radiographic test:
   Chest Xray P/A   Xray Pelvis A/P   Sometime MRI sacroiliac joint   USG of the joint